RFI Browser

RFI # 225:
4010 271 EB03 min required

Informal
Formal

Submitter

chuck wilhelm

Description

Section 1.3.7 and segment note 5 for 2110C EB segment and segment note 4 for 2110D EB segment indicate the minimum compliant response when the patient is found in the Information Source’s system. For the minimum compliant response, when returning the 2110C or 2110D EB for a patient who has been located in their system with Active or Inactive coverage, must that same EB segment contain a value of “30” in EB03 or are other values allowable if those values are more appropriate?

Response

If the 270 request contained a value of “30” in the EQ01, you are required to return a value of “30” in EB03 in conjunction with the Active or Inactive values of “1” through “8” transmitted in EB01. Section 1.3.7 sets the minimum requirement for the 271 response of returning any information sent in the 270 transaction used in the processing of the 271 response.

If the 270 request contained a value other than “30” in EQ01 or a procedure code in EQ02 and the information source supports this level of functionality, it is not necessary to transmit a value of “30” in EB03 in conjunction with the Active or Inactive values of “1” through “8” transmitted in EB01.

The use of EB03 is dependent upon what was submitted in the 270 transaction and the level of support the information source has for service type codes other than “30” in EQ01 or support of the Composite Medical Procedure Identifier in EQ02.